Is there anything that would prevent you from performing the essential duties of the job(s) for which you have applied? *

Yes
No

Have you ever been convicted of a criminal offense for which you have not received a pardon?*

Yes
No

How did you hear about Grey Bruce Health Services?*
GBHS Web site
Other Web site
Newspaper
Magazine
Job Fair
Another Employee(Referral)
(employee name)
Word of Mouth
Facebook
Poster/Bulletin
Other

Please attach your resume in a word(.doc) or PDF(.pdf) format:

OR
Copy and paste your resume here.

Nursing Applicants:
Clinical Areas Preferred

Ontario Certificate of
Competence Number

Date of
Last Renewal

Has your license ever been revoked/reduced/restricted or suspended?

Yes
No

Level of C.P.R. Certification
Heart Saver
B.C.L.S.
A.C.L.S.
P.A.L.S.

Date of Expiry of C.P.R. Certification

Professional Associations - Include Name
of Asssociation, Current and Pending Registration, and Registration
Number

Other Work Related Skills - Describe any
skills, training or experience (including volunteer work)
that may relate to the position applied for

Acknowledgment

By submitting this information, I hereby certify that all the statements made by me on this application form and/or resumé are true and complete and I understand that a misrepresentation or omission of the facts will constitute full and sufficient grounds for rejection of this application or for dismissal of employment. I understand it is the policy of Grey Bruce Health Services (GBHS) to conduct a Criminal Background Check which may preclude me from obtaining employment. In the event that GBHS further pursues my candidacy, I understand that GBHS will notify me of its intent to investigate my previous employment, educational data, references and background checks and permission is hereby given. I also understand that if employment is offered pending satisfactory completion of the background check or reference checks and if either is not satisfactory to GBHS, the employment offer will be rescinded. I understand that should I be successful in obtaining employment with GBHS, the cost of the criminal background check will be deducted from my pay, and I hereby grant permission to do so. I also understand that employment is subject to the completion of a health review.